Cho S, Choi J H, Sung K J, Moon K C, Koh J K
Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea.
Int J Dermatol. 2001 Apr;40(4):276-7. doi: 10.1046/j.1365-4362.2001.01108.x.
A 67-year-old man presented with a 2-year history of asymptomatic, firm, multiple nodules and plaques and cerebriform hypertrophy of both lower legs and feet, and well-defined, skin-colored, firm nodules and tumors on both hands. He had been diagnosed as having Graves' disease 3 years previously, and had been treated with 10 mg of methimazole and 100 microg of thyroxin (T4) daily for 2 years. Physical examination revealed nonpitting edema, flesh-colored to erythematous, firm, confluent, polypoid nodules and fissured plaques extending from the shins to the dorsa of both feet (Fig. 1), and round to oval, firm, skin-colored, walnut-to-egg-sized tumors on all 10 fingers and the ulnar side of the dorsum of the right hand (Fig. 2). The thyroid gland was diffusely enlarged; however, there was no exophthalmos, and extraocular movements were normal. There was no weight loss, loss of appetite, tremor, heat intolerance, diarrhea, or fatigue. On laboratory evaluation, thyroid-stimulating hormone (TSH) had a markedly low titer of < 0.05 microU/mL (normal: 0.4-5.0), and the TSH receptor antibody was extremely high at 73.8% (normal: < 15%). Serum free triiodothyronine (T3), T4, antimicrosome, and antithyroglobulin antibodies were normal or negative. Skin biopsy samples from the shin and hand disclosed extensive mucin deposition throughout the dermis.
一名67岁男性，双下肢和足部出现无症状、质地坚硬的多个结节、斑块及脑回状肥厚2年，双手有边界清晰、肤色、质地坚硬的结节和肿瘤。他3年前被诊断为格雷夫斯病，接受甲巯咪唑10mg及甲状腺素（T4）100μg每日治疗2年。体格检查发现非凹陷性水肿，从胫骨延伸至双足背有肉色至红斑色、质地坚硬、融合性、息肉样结节及裂隙性斑块（图1），双手10个手指及右手背尺侧有圆形至椭圆形、质地坚硬、肤色、核桃至鸡蛋大小的肿瘤（图2）。甲状腺弥漫性肿大；然而，无突眼，眼球运动正常。无体重减轻、食欲减退、震颤、不耐热、腹泻或疲劳。实验室检查显示，促甲状腺激素（TSH）滴度显著降低，<0.05μU/mL（正常：0.4 - 5.0），促甲状腺激素受体抗体极高，为73.8%（正常：<15%）。血清游离三碘甲状腺原氨酸（T3）、T4、抗微粒体及抗甲状腺球蛋白抗体正常或阴性。取自胫骨和手部的皮肤活检样本显示真皮内广泛黏蛋白沉积。
